RBC Abnormalities

Acanthocytes

Red blood cells with

irregularly spaced
projections
Found in
abetalipoproteinemia
and certain liver
disorders
Echinocytes
Red blood cells with
many blunt spicules,
resulting from faulty
drying of the blood
smear or from
exposure to
hyperosmotic
solutions
Pathological forms
are associated with
uremia
Codocytes

Red blood cells with

a central color spot
in the area of pallor,
resembling a target
Seen in
hemoglobinopathies
and thalassemia
Spherocytes
Red blood cells that are
almost spherical in
shape; have no area of
central pallor like a
normal red blood cell
Seen in hemolytic
anemia
Small spherocytes
(microspherocytes) are
sometimes seen in
severe burn cases
Stomatocytes

Red blood cells with

an mouth-like or slit-
like pallor area
Found in hereditary
stomatocytosis and
Rh null disease
Elliptocyte

Red blood cells that

are oval or cigar
shaped
Found in various
anemias, but are
found in large
amounts in
hereditary
elliptocytosis
Schistocytes
Red blood cell
fragments that result
from membrane damage
encountered during
passage through vessel
Occur in
microangiopathic
hemolytic anemia,
severe burns, uremia,
and hemolytic anemias
caused by physical
agents
Dacrocytes
Teardrop shaped red
blood cells are found
in myelofibrosis and
other
myeloproliferative
disorders, pernicious
anemia,
thalassemia, myeloid
metaplasia, and
some hemolytic
anemias
Drepanocytes

Red blood cells that

have become
crescent shaped
Found in sickle cell
anemia
Howell-Jolly bodies

Spherical blue-black
inclusions of red
blood cells seen on
Wright-stained
smears
Nuclear fragments of
condensed DNA
Pappenheimer bodies

Iron containing
granules in red blood
cells
Appear as faint violet
or magenta specks,
often in small
clusters, due to
staining of the
associated protein
Basophilic Stippling

Round, dark-blue
granules in red blood
cells on smears
Observed in lead
poisoning
Polychromatophilic RBC
Immature peripheral red
blood cells that have a
blue-gray tint on Wright-
stained smears,
indicating the presence
of cytoplasmic RNA
Cells prove to be
reticulocytes when
stained with supravital
stains such as brilliant
cresyl blue
Appear under conditions
of accelerated red cell
production
Rouleaux formation
Stack of coins
arrangement of red
blood cells
Due to the presence of
high concentrations of
abnormal globulins or
fibrinogen
Found in multiple
myeloma and
macroglobulinemia
WBC Abnormalities
Hypersegmentation

Neutrophils with >5

lobes
Seen in disorders of
nuclear maturation,
such as the
megaloblastic
anemias
Auer Rods
Elongated, bluish-red
rods composed of fused
lysosomal granules
Seen in the cytoplasm of
myeloblasts,
promyelocytes and
monoblasts and in
patients with acute
myelogenous leukemia
Dohle bodies

Appear as a small,
light blue-gray
staining area in the
cytoplasm of the
neutrophil
Found in poisoning,
infections, and
following
chemotherapy.
Atypical Lymphocytes
Atypical, or reactive,
lymphocytes are
lymphocytes that, as a
result of antigen
stimulation, have
become quite large
Causes of reactive
lymphocytosis may be:
cytomegalovirus, drugs,
Epstein-Barr virus
(infectious
mononucleosis),
syphilis, toxoplasmosis
and viral hepatitis.
Hairy Cells

Characterized by
their fine, irregular
pseudopods and
immature nuclear
features
Seen only in hairy
cell leukemia
Smudge Cells and Basket Cells
Smudge cells or basket
cells are leukocytes that
have been damaged
during preparation of the
peripheral blood smear
Usually occurs due to
the fragility of the cell
Usually seen in chronic
lymphocytic leukemia
(CLL)
Acute Leukemia
Acute Leukemia
Group of stem cell disorders with
unregulated proliferation and accumulation
of immature cells

Cells have little maturation, being primarily

blast cells
Acute Myelocytic
Leukemia
Results from uncontrolled proliferation of the
myeloblast and immature cells of the myeloid
series
Diagnosis of AML is established when 30% or
more of the nucleated cells of the bone marrow are
blasts
M0 AML Undifferentiated
>30% blasts
Blasts nondescript
with no granules in
the cytoplasm
M1 AML Without Maturation
>30% blasts
<10% granulocytic
<10% granulocytic

Nucleus: One or more nucleoli;

fine chromatin
Cytoplasm: Few azurophilic
granules; Auer rods
M2 AML With Maturation
>30% blasts
>10% promyelocytes
<50% erythroid
>10% granulocytic
<20% monocytic
Nucleus: One or more nucleoli;
fine chromatin
Cytoplasm: Numerous
azurophilic granules; Auer rods
M3 Acute Promyelocytic
>30% blasts
>50%
promyelocytes
<50% erythroblasts
>10% granulocytes
<20% monocytes
Nucleus: Bilobed shape
Cytoplasm: Heavy granulation,
bundles of Auer rods (Faggot
cells)
M4 Acute Myelomonocytic
>30% blasts
>20% granulocytic
>20% promyelocytes
>20-<80%
monocytes
M5a Acute Monoblastic Poorly
Differentiated
>80% monocytic
>80% monoblasts
Monoblasts
predominate, few
promonocytes
Nucleus: Lacy chromatin with
nucleoli
Cytoplasm: Basophilic;
pseudopods; occasional
granules
M5b Acute Monoblastic with
Differentiation
80% monocytic
<80% monoblasts
Promonocytes
predominate in the
marrow
Monocytes predominate
in blood
Nucleus: Cerebriform shape
with nucleoli
Cytoplasm: Grayish, ground-
glass appearance; fine
azurophilic granules
M6 Acute Erythroleukemia
>30% myeloblasts
>50% erythroid cells
in all stages of
maturation

Nucleus: Multiple nuclei,

nucelar fragments
Cytoplasm: PAS positive;
vacuolization
M7 Acute Megakaryocytic
>30% blasts
>30%
megakaryocytic
cells

Nucleus: Dense chromation or

fine reticulated chromatin with
nucleoli
Cytoplasm: Scant; vacuoles
Acute
Lymphoblastic
Leukemia
Acute Lymphoblastic Leukemia
L1
Lymphoblasts are
small and
homogenous, with
scanty cytoplasm and
inconspicuous
nucleoli; the nucleus is
large and irregular in
shape
Most common type
(84%) of childhood
ALL
Acute Lymphoblastic Leukemia
L2
Lymphoblasts are
larger and variable in
size with basophilic
cytoplasm, and nuclei
are clefted with
nucleoli present
Accounts for 14% of
the cases of childhood
ALL, and includes
64% of the adult type
of ALL
Acute Lymphoblastic Leukemia
L3, Burkitt-type
Lymphoblast is large,
but vary little in size;
cytoplasm is moderate
in quantity and deeply
basophilic, often with
prominent vacuoles
Accounts for only
about 2% of the cases
of ALL